Anastomosis system for performing anastomosis in body

ABSTRACT

There is provided an anastomosis system for performing an anastomosis in a body. The system includes an anastomosis button, which has two foldable flange portions and a tubular main body portion extending between the flange portions, for coupling two lumen portions in the body to each other, and a housing which can receive the anastomosis button as the flange portions are folded. The system further includes a guide, which has a distal end to be inserted through a patient&#39;s mouth to a target portion in the body and a proximal end arranged outside the body, for guiding the housing to the target portion. A release line having a distal end to be inserted to the target portion along the guide and a proximal end held outside the body is operated, whereby the anastomosis button can be ejected from the housing and be held at the target portion.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Application No.60/352,727, filed Jan. 30, 2002.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to an anastomosis system and, moreparticularly, to an anastomosis system used for, e.g., agastrointestinal anastomosis to couple two organs or lumen portions in aliving body to each other.

2. Description of the Related Art

In recent years, treatments using an endoscope have progressedremarkably, so that treatment can be accomplished without major surgeryinvolving a large incise in the abdomen. Particularly, an anastomosis oftubular organs or blood vessels in the coelom is a very importanttechnique upon treatment under observation via the endoscope.Accordingly, various treatment techniques using the endoscope have beendeveloped.

For example, U.S. Pat. No. 5,425,738 discloses an endoscopic insertiondevice for inserting an anastomosis ring including two members, whichcan be engaged with each other, into a tubular tissue such as a bloodvessel or a large intestine. The insertion device includes an outersleeve which has a stop portion at its distal end and an obturator,which is inserted through the outer sleeve, and has an inflatable cuffat its distal end. In the state in which the cuff is partially inflated,the anastomosis ring can be inserted into the tubular tissue. After thetubular tissue is fixed to the members of the anastomosis ring, themembers are closed to anastomose the tubular tissue fixed to themembers.

U.S. Pat. No. 5,441,507 discloses a technique for anastomosing tubularorgans under observation via an endoscope. According to the disclosedtechnique, one end of a first severed intestinal segment is purse-stringsutured, an end cap of an anastomosis device is inserted into the firstintestinal segment, and after that, the first intestinal segment isanastomosed to a second intestinal segment.

Furthermore, Jpn. Pat. Appln. KOKAI Publication No. 6-47050 discloses atissue suture ligature device to be inserted to a tubular organ. Theligature device has an annular staple releasing section and an anvilopposite thereto. The anvil is axially moved to bend the legs of staplespenetrating a tissue, thereby performing a suture.

The anastomosis ring disclosed in U.S. Pat. No. 5,425,738 has arelatively large diameter. Accordingly, after the abdomen is pierced, itis necessary to insert the ring through a formed orifice into a coelom.Accordingly, a plurality of orifices formed by piercing the abdomen arerequired to insert a celoscope in addition to the insertion device. Inthe technique disclosed in U.S. Pat. No. 5,441,507, the anastomosis ringis not used. However, since the anastomosis device is relatively largeand hard, it is necessary to form a plurality of orifices in theabdomen. As to the ligature device disclosed in Jpn. Pat. Appln. KOKAIPublication No. 6-47050, since the ligature is accomplished by using thestaples, it is difficult to reduce the diameter of the ligature device.

Accordingly, demanded is the development of an anastomosis system whichis inserted together with an endoscope through the mouth or the anusinto the coelom to further reduce the burden on a patient.

BRIEF SUMMARY OF THE INVENTION

The present invention is made in consideration of the related arts andit is an object of the present invention to provide an anastomosissystem in which an anastomosis button is inserted through the mouth orthe anus into the coelom to further reduce the burden on the patient.

To accomplish the above object, according to the present invention, theanastomosis system to perform an anastomosis in a body includes ananastomosis button, which has two foldable flange portions and a tubularmain body portion extending between the flange portions for coupling twolumen portions in the body to each other. The anastomosis button isreceived in a housing as the flange portions are folded and is insertedthrough at least one of the mouth or the anus to a target portion in thebody. A guide, which guides the housing to the target portion in thebody, includes a distal end to be inserted into the body and a proximalend arranged on the outside of the body. To eject the anastomosis buttonfrom the housing inserted to the target portion in the body through theguide, the anastomosis button further includes a release line, whichincludes a distal end to be inserted to the target portion along theguide and a proximal end held on the outside of the body, for ejectingthe anastomosis button from the housing to be held in the target portionby operating the proximal end on the outside of the body.

In the anastomosis through the anastomosis system, since the anastomosisbutton is received in the housing as the flange portions are folded,even when the flange portions of the anastomosis button are large, theconstitution of the anastomosis button is compact upon insertion. Whenthe anastomosis button is ejected from the housing by operating therelease line on the outside of the body, the anastomosis button isreturned to the original form, whereby the two lumen portions can becoupled to each other. The ejection of the anastomosis button from thehousing can be surely disposed at a correct position under observationvia the endoscope inserted through the guide.

According to another aspect of the present invention, there is providedan improved anastomosis for anastomosing two lumen portions in a body.The anastomosis includes the steps of: providing an anastomosis button,which includes two foldable flange portions and a tubular main bodyportion extending between the flange portions, for coupling the twolumen portions in the body to each other; receiving the anastomosisbutton in a housing as the flange portions are folded; inserting amulti-lumen tube through either the mouth or the anus until the distalend of the tube reaches a target portion in the body; inserting anendoscope into the tube; piercing a coelom wall and holding thecorresponding coelom wall to be anastomosed with a forceps or a wirewith a needle inserted through either the tube or the endoscope topierce the corresponding organic wall under observation via theendoscope; ejecting the anastomosis button from the housing to insertthe main body portion of the anastomosis button into the orifices of thetwo coelom walls previously pierced; and holding the two coelom wallsbetween the two developed flange portions.

Additional objects and advantages of the invention will be set forth inthe description which follows, and in part will be obvious from thedescription, or may be learned by practice of the invention. The objectsand advantages of the invention may be realized and obtained by means ofthe instrumentalities and combinations particularly pointed outhereinafter.

BRIEF DESCRIPTION OF THE SEVERAL VIEWS OF THE DRAWING

The accompanying drawings, which are incorporated in and constitute apart of the specification, illustrate embodiments of the invention, andtogether with the general description given above and the detaileddescription of the embodiments given below, serve to explain theprinciples of the invention.

FIG. 1 is a schematic diagram showing the entire structure of ananastomosis system according to a preferred embodiment of the presentinvention;

FIG. 2A is a schematic diagram explaining the arrangement of members inthe distal end of a guide tube of the anastomosis system in FIG. 1;

FIG. 2B is a perspective view showing a developed anastomosis button;

FIG. 3A is a sectional view showing an internal portion of the guidetube in FIG. 2A;

FIG. 3B is a cross-sectional view taken along a line B-B in FIG. 3A;

FIG. 3C is a cross-sectional view taken along a line C-C in FIG. 3A;

FIG. 4 is an explanatory diagram showing a state in which a part of anintestine is pulled into a stomach through a stomach wall pierced by theanastomosis system in FIG. 1;

FIG. 5 is an explanatory diagram showing a state in which, in the stateshown in FIG. 4, the intestine is pierced and a housing is insertedthereto;

FIG. 6 is an explanatory diagram showing a state in which a part of theanastomosis button is ejected from the housing;

FIG. 7 is an explanatory diagram showing a state in which the ejectionof the anastomosis button from the housing is completed;

FIG. 8 is a sectional view showing a state in which the stomach wall andan intestine wall are subjected to the anastomosis with the anastomosisbutton;

FIG. 9A is a sectional view showing a part of an anastomosis systemaccording to another embodiment;

FIG. 9B is a schematic perspective view of an anastomosis button used inthe anastomosis system in FIG. 9A;

FIG. 10 is an explanatory diagram showing a state according to theanastomosis system in FIG. 9A, the state being similar to that in FIG.5;

FIG. 11 is an explanatory diagram showing a state in which theanastomosis button is ejected from a housing in the anastomosis systemin FIG. 9A;

FIG. 12 is a sectional view showing a state in which an anastomosis isperformed with the anastomosis button shown in FIG. 9B, the state beingsimilar to that shown in FIG. 8;

FIG. 13 is an explanatory diagram showing a state in which an intestinewall is held by a wire with a needle;

FIG. 14A is a sectional view showing a state in which an anastomosis isperformed by using an anastomosis system according to further anotherembodiment;

FIG. 14B is a schematic exploded perspective view of an anastomosisbutton used in the anastomosis system in FIG. 14A;

FIG. 15 is an explanatory diagram showing the insertion of a member ofthe anastomosis button shown in FIG. 14B;

FIG. 16 is an explanatory diagram showing a state in which the othermember of the anastomosis button is attached to the member, which ispreviously inserted;

FIG. 17 is an explanatory diagram showing the ejection of the othermember shown in FIG. 14B;

FIG. 18 is a sectional view showing a state in which the anastomosis isperformed by the anastomosis button shown in FIG. 14B;

FIG. 19 is an explanatory diagram showing a state in which theanastomosis is performed by using the anastomosis system shown in FIG.14A; and

FIG. 20 is a sectional view of a modified anastomosis button.

DETAILED DESCRIPTION OF THE INVENTION

Referring to FIG. 1, an anastomosis system 10 according to a preferredembodiment of the present invention is suitable for a gastroenterostomyin a treatment for, particularly, obesity. The system is not limitedthereto. The anastomosis system 10 has a guide 12 shaped into a flexibletube which can be inserted through a mouth. As to the guide 12 accordingto the present embodiment, at least its distal end is made oftransparent resin. At the distal end to be inserted to the coelom, aplane at the distal end is inclined in the longitudinal direction of theaxis. In the vicinity of the plane at the distal end, an orifice 14 tobe opened on the side is formed. A holding instrument 18 such as agrasping forceps (in FIG. 1, only one is shown), a housing operationshaft 20 for operating a housing, which will be described below, and anendoscope 22 are inserted through an operation section main body 16arranged on the outside of a body into the guide, so that the distalends thereof are guided to a target portion in the coelom. Since atleast the distal end of the guide 12 is made of the transparent resin,even when the distal end 22 a of the endoscope 22 is not protruded fromthe guide 12, the coelom can be observed through the endoscope 22.

Referring to FIGS. 2A to 3C, the distal end 22 a of the endoscope 22inserted through the guide 12 can be protruded outwardly in the radialdirection from the inside of the guide 12 through the side orifice 14opened in the vicinity of the plane at the distal end of the guide 12.According to the present embodiment, therefore, illumination lightguided through a light guide (not shown) is irradiated from anillumination window 24 a, which is formed on the surface at the distalend 22 a, to a predetermined portion in the coelom, so that reflectedlight incident on an observation window 24 b can be guided to anendoscope operation section 26 arranged on the outside of the bodythrough an image guide (not shown). Reference numeral 28 a shown in FIG.2A denotes a channel through which an operative instrument such as aforceps or a high-frequency knife is inserted. Reference numeral 28 bdenotes a nozzle for ejecting water or air.

Further, in the guide 12, a large-diameter lumen 30 through which theendoscope 22 is inserted and a plurality of small-diameter lumens 32 and34 are formed. According to the present embodiment, through each of thesmall-diameter lumens 32, a shaft of the holding instrument 18 having,for example, a grasping forceps 19 at the distal end is inserted. Thehousing operation shaft 20 is inserted through the small-diameter lumen34. As shown in FIGS. 3A to 3C, in the vicinity of the distal end of theguide 12, the lumens 30 to 34 constitute a common lumen 36 as a spacewith a large diameter. In FIG. 3A, reference symbol α designates an areawhere the common lumen 36 is formed and reference symbol β designates anarea where the lumens are formed. The side orifice 14 is not alwaysformed in the area α. Preferably, the orifice 14 is formed in thevicinity of the distal end of the guide 12.

In the area α formed as mentioned above, namely, the area where thecommon lumen 36 with a large diameter is formed, a housing 44 receivingan anastomosis button 42 having two flange portions 38 and a tubularmain body portion 40 extending between the flange portions (refer toFIG. 2B) is arranged. Accordingly, the dimension of the common lumen 36in the axial direction is preferably set so that the housing 44 can bereceived fully.

The anastomosis button 42 is made of a flexible or elastic materialwhich can be deformed. Particularly, the flange portions 38 are foldedto be received in the housing 44. When they are ejected from the housing44, the flange portions 38 can be immediately returned to the originalform. Moreover, as will be explained below, the anastomosis button 42has such strength that, for example, when a stomach wall is anastomosedto an intestine wall, the two wall portions can be tightly held untilthey adhere to each other.

The housing 44 receiving the above-mentioned anastomosis button 42 isconstituted of two cylindrical portions 44 a and 44 b which are engagedwith each other in a telescopic manner in the present embodiment.Particularly as shown in FIG. 3A, the cylindrical portions 44 a and 44 bare formed so that the elongated cylindrical portions are substantiallyequivalent to the axial length of the anastomosis button 42 elongated inan hourglass-shaped form as the two flange portions 38 are foldedoppositely. The operation shaft 20 is fixed to either one of thecylindrical portions 44 a and 44 b. According to the present embodiment,the end of the cylindrical portion 44 a, which is located at the distalend of the housing 44, is tapered so as to be easily inserted into apierced coelom wall. Since the sloped plane is formed at the distal end,when the anastomosis button 42 is ejected from the housing 44, theposition of the anastomosis button 42 can be easily confirmed throughthe endoscope 22.

Subsequently, processing of, for example, a gastroenterostomy with theanastomosis system 10 will now be described.

As preparation before the operation, the anastomosis button 42 is foldedin an hourglass-shaped form and is then stored in the elongated housing44. The housing 44 receiving the anastomosis button 42 therein isdisposed in the large-diameter common lumen 36 formed at the distal endof the guide 12. The operation shaft 20 is inserted through the lumen34. As shown in FIG. 1, an operation section of the shaft is disposed onthe outside of the operation section main body 16. If necessary, theholding instruments 18 having the grasping forceps 19 at the distal endare also received in the common lumen 36 at the distal end of the guide12 and the shafts thereof are inserted to the lumens 32. The operatorinserts their thumb into a ring shown by reference numeral 18 a in FIG.1 and then moves the thumb with respect to a slider 18 b and the ring 18a, so that a pair of jaws of each grasping forceps 19 can be opened orclosed.

Subsequently, the distal end of the guide 12 prepared as mentioned aboveis inserted into the stomach of a patient through their mouth andesophagus and is then disposed at a desired portion. The state can beconfirmed via the endoscope 22 previously inserted in the lumen 30, theendoscope being inserted subsequent to the guide 12. Particularly, whenthe endoscope 22 is inserted together with the guide 12, theconfirmation can be easily made because the guide 12 is made of thetransparent material.

After the distal end of the guide 12 reaches the desired position, thedistal end 22 a of the endoscope 22 is extended outwardly through theside orifice 14 of the guide 12 and the end surface of the distal end isaimed to a portion 92 to be pierced (refer to FIG. 4) of the stomachwall 90. After that, an incision instrument such as a high-frequencyknife is inserted through, for example, the channel 28 a (FIG. 2A) inthe endoscope 22 to pierce the portion 92. At that time, the desiredportion is held or pulled by the grasping forceps 19 while the portion92 to be pierced of the stomach wall 90 is monitored by the endoscope22, so that the portion can be surely easily pierced.

FIGS. 4 through 8 show a processing of anastomosing a small intestine 94to the above-mentioned pierced portion 92 of the stomach wall.

As shown in FIG. 4, the two grasping forceps 19 (FIG. 4 shows only oneof them) are advanced from the guide 12 under observation via theendoscope 22 to grasp the small intestine 94 and pull it into thestomach through the pierced portion 92 formed in the stomach wall. Thesmall intestine 94 is also pierced by the incision instrument such as ahigh-frequency knife inserted through the channel in the endoscope 22.

After that, as shown in FIG. 5, the operating section of the operationshaft 20 is operated outside the body to protrude the housing 44 fromthe distal end of the guide 12 and then insert the housing 44 throughthe pierced portion in the small intestine 94. When the cylindricalportion 44 a at the distal end in which one of the flange portions 38 isreceived is inserted into the small intestine 94, the insertion of thehousing 44 is stopped. When the housing 44 is protruded from the guide12, the common channel 36 serves as a free space.

As shown in FIG. 6, the distal end 22 a of the endoscope 22 is insertedinto the common channel serving as a free space. A release lineillustrated by a grasping forceps 46 shown in FIG. 6 is advanced towardthe housing 44 through the channel 28 a in the endoscope 22. Theoperation shaft 20 or grasping forceps 46 is moved to telescope thecylindrical portions 44 a and 44 b of the housing 44, thereby extrudingone of the flange portions 38 of the anastomosis button 42 into thesmall intestine 94. The flange portion 38 extruded in the smallintestine 94 is returned to the original circular form by elasticity, sothat the flange portion is brought into contact with the inner surfaceof the small intestine 94. Furthermore, when the operation shaft 20 ispulled out of the pierced portion 92 in the stomach wall 90 while theanastomosis button 42 in the housing 44 is retained by the graspingforceps 46 or release line, the other flange portion 38 is ejected fromthe housing 44 and is then returned to the original circular form byelasticity, so that the flange portion 38 is brought into contact withthe inner surface of the stomach wall 90. FIG. 7 shows such a state.

Referring to FIG. 8, since the main body portion 40 of the anastomosisbutton 42 is shaped tubularly, two lumen portions of the stomach and thesmall intestine are coupled to each other through an orifice 41.Consequently, food fed to the stomach is immediately transferred to thesmall intestine 94, so that digestive and assimilative operations arenot performed in the stomach. The anastomosis button 42 for anastomosingthe stomach to the small intestine is held in the patient's body in thisstate for, e.g., about one week. After the pierced portions have adheredto each other, the button is extracted from the body. The anastomosisbutton 42, particularly, the flange portions 38 thereof are formedflexibly. Accordingly, when the flange portions 38 are grasped and thenpulled by the grasping forceps, the anastomosis button can be easilyremoved from the pierced portion 92 in the stomach wall 90. Theanastomosis button 42 can be easily removed by merely inserting thegrasping forceps through the normal endoscope.

According to the anastomosis system 10 of the present embodiment,therefore, the anastomosis button 42 can be inserted together with theendoscope 22 through the mouth into the coelom. The gastroenterostomycan be performed remarkably easily. The patient is not burdenedsubstantially. Moreover, since the housing 44 receiving the anastomosisbutton 42 therein is constituted of the remarkably simple cylindricalmembers, a special device is not needed, so that the anastomosis systemis formed at extremely low cost.

FIGS. 9A through 12 show an anastomosis system according to anotherembodiment. Since the fundamental principle of the present embodimentdescribed hereinafter is the same as that of the foregoing embodiment,the same components are designated by the same reference numerals andthe detailed description is omitted.

As shown in FIG. 9A, a housing 54 according to the present embodimentincludes a cylindrical portion 54 a having a tapered distal end and abottom wall portion 54 b provided at the proximal end of the cylindricalportion. In the tapered end, at least one slit 56 is formed (it ispreferable to form plural slits). Accordingly, the diameter of thetapered distal end can be enlarged. In the bottom wall portion 54 b, aflexible guide tube 60, through which a guide wire 58 can be inserted,is fixed and an opening portion 62 is formed. The guide tube 60 isprotruded from the distal end of the housing 54 so that it can guide thehousing 54 while sliding along the guide wire 58 inserted therethrough.The housing 54 is held more surely than the case where the housing isheld by the operation shaft 20 alone. The housing 54 is surely andeasily guided to a desired position. An anastomosis button in thehousing 54 is received on the guide tube 60.

As shown in FIG. 9B, in an anastomosis button 42A according to thepresent embodiment, a rim 39 is provided for the periphery of eachflange portion 38 to increase the bending strength of the flange portion38. Accordingly, even when the diameter of the penetrating orifice 41 isincreased, the stomach wall 90 and the intestine wall 94 can be surelyheld without increasing the outer diameter or thickness of the flangeportion 38. The rims 39 can be protruded so as to face each other. Toallow the rims 49 to be smoothly in contact with the stomach wall 90 andthe intestine wall 94, preferably, they are protruded opposite to eachother as shown in FIG. 9B.

As shown in FIG. 9A, after the housing 54 according to the presentembodiment is protruded from the common lumen 36 of the guide 12, it canbe offset outwardly in the radial direction from the axis in thelongitudinal direction of the guide 12 by the operation shaft 20 and theguide wire 58. Consequently, the distal end 22 a of the endoscope 22 canbe linearly advanced from the common lumen 36 of the guide 12 past thehousing 54. In this case, it is unnecessary to form the side orifice 14in the foregoing embodiment.

The anastomosis system according to the present embodiment can be usedin a manner similar to the foregoing embodiment. According to thepresent embodiment, since the distal end 22 a of the endoscope 22 can belinearly advanced past the housing 54, the stomach wall 90 and theintestine wall 94 can be pierced in a state in which the surface at thedistal end of the endoscope is disposed substantially parallel to thewalls.

After the stomach wall 90 and the intestine wall 94 are pierced by ahigh-frequency knife, for example, the guide wire 58 can be insertedthrough the pierced portion before the housing 54 is inserted.Consequently, the housing 54 can be accurately and rapidly insertedthrough the pierced portion while the guide tube 60 is slid along theguide wire 58. In the case where the housing 54 is inserted through thepierced portion, since the distal end thereof is tapered, the housing 54can be smoothly inserted into the small intestine even by a slightforce. FIG. 10 shows the state in which the distal end of the housing 54is inserted through the pierced portion.

When the anastomosis button 42A is ejected from the housing 54, thedistal end of a release line such as a grasping forceps extendingthrough the channel in the endoscope 22 is inserted into the housing 54through the opening portion 62 formed in the bottom wall portion 54 b.While the operation shaft 20 or the release line is being movedrelatively, the anastomosis button 42A is moved to a front portion inthe housing 54. Referring to FIG. 11, the slits 56 formed at the tapereddistal end are opened to enlarge the diameter of the tapered distal end.When the flange portion 38 at the distal end of the received anastomosisbutton 42A is ejected from the housing 54, the flange portion 38 isspread and returned to the original circular shape due to elasticity, sothat the flange portion 38 is brought into contact with the innersurface of the intestine wall 94. After that, when the operation shaft20 and the guide wire 58 are pulled out of the anastomosis button 42A,the anastomosis button 42A is held to anastomose the small intestine tothe stomach as shown in FIG. 12. The rim 39 protruded from the flangeportion 38 prevents the flange portion 38 from bending. Accordingly, therim 39 prevents the anastomosis button 42A from being detached from thepierced portion. FIG. 20 shows a modified button 42C with a roundedshape.

FIGS. 13 through 19 show further another embodiment.

FIG. 13 shows a technique for pulling the intestine wall 94 of the smallintestine in the present embodiment. In the technique, in stead ofpulling the intestine wall 94 into the stomach through the piercedportion 92 in the stomach wall 90, the intestine wall 94 is drawn to thestomach wall 90 by a piercing needle 66 inserted through the channel 28a in the endoscope 22. The piercing needle 66 is formed as a longdrawing line formed by inserting a needle wire 66 b through a needlesheath 66 a. The distal end of the needle wire 66 b is coiled to form aneedle portion. The needle wire 66 b is inserted together with theneedle sheath 66 a into the intestine wall and the needle sheath 66 aalone is removed. Consequently, the coiled needle at the distal end ofthe needle wire 66 b is held in the intestine wall 94. Alternatively,the coiled needle pierces the intestine wall 94 to prevent the needlewire 66 b from being removed from the intestine wall 94. In this state,the needle wire 66 b is drawn in the direction toward the patient'smouth and is then fixed to an external portion of the body, so that itis possible to hold the state in which the intestine wall 94 is pulledto the stomach wall 90.

As shown in FIG. 14A, ordinarily, it is preferable that the intestinewall 94 be drawn to the stomach wall 90 at portions opposite to thediameter of the pierced portion 92 by using two piercing needles 66.

Furthermore, as shown in FIG. 14B, according to the present embodiment,an anastomosis button 42B is constituted of a first segment 43, whichhas the tubular main body portion 40 and the flange portion 38, and asecond disc-like segment 38 a that is fitted to the main body portion 40of the first segment. The end of the main body portion 40 has a taperedshape so that the second segment 38 a can be easily attached thereto.The second segment 38 a is fitted to the first segment 43, therebyforming the flange portion opposite to the flange portion 38 of thefirst segment 43. The distance between the flange portions can becontrolled in accordance with the thickness of the patient's stomachwall 90 and intestine wall 94. The entire anastomosis button 42Baccording to the present embodiment is round, so that it comes smoothlyinto contact with the stomach wall and the small intestine wall. Theanastomosis button has a configuration that is friendly to a mucousmembrane.

Referring to FIGS. 14A and 15 through 17, a housing 64 receiving theanastomosis button 42B therein has an inner cylindrical portion 64 athat is attached to the distal end of the endoscope 22 and an outercylindrical portion 64 b that is slidably attached onto the innercylindrical portion 64 a. Between the two cylindrical portions, eitherthe first segment or the second segment of the anastomosis button 42B isfolded and they can be received. In the present embodiment, twooperation wires 68 as release lines are connected to the outercylindrical portion 64 b. Each operation wire 68 is inserted through atube sheath 70 and extends to an operation section of the endoscope 22shown in FIG. 19. In FIG. 19, reference numeral 72 denotes an operationknob for the outer cylindrical portion which is connected to theoperation wire 68 and reference numeral 74 denotes an operation mainbody for the outer cylindrical portion which is connected to the tubesheath 70.

FIG. 14A shows a state in which the first segment 64 a of theanastomosis button 42B is received. FIG. 16 shows a state in which thesecond segment 64 b is received. As shown in the drawings, the housing64 can receive the first segment 43 and the second segment 38 a of theanastomosis button 42B in an annular gap between the inner and outercylindrical portions 64 a and 64 b. In the case where the seconddisc-like segment 38 a is received, as shown in FIGS. 16 and 17, buttondischarging threads 78 in which spherical beads 76 are connected to thedistal ends are preferably used as release lines in addition to theoperation wire 68.

Before the second segment 38 a is attached onto the inner cylindricalportion 64 a, the discharging thread 78 is inserted through the channel28 a in the endoscope 22 into the inner cylindrical portion 64 a todispose the beads 76 at both the distal ends on the outer peripheralsurface of the cylindrical portion. After that, the second segment 38 ais attached to the reduced diameter portion of the inner cylindricalportion 64 a and is then covered with the outer cylindrical portion 64b. The proximal end of each discharging thread 78 extends outwardly fromthe operation section of the endoscope 22 and is then fixed to a buttonoperation main body 82, which is rotated by a rotation knob 80, as shownin FIG. 19. The rotation knob 80 is rotated to wind the dischargingthreads 78 around the button operation main body 82. Consequently, thedischarging threads 78 are pulled toward the proximal ends, so that thebeads 76 discharge the second segment 74 b out of the housing 64.Preferably, a plurality of discharge threads 78 are used as shown inFIGS. 16 and 17. One discharging thread can be also used.

The attachment of the anastomosis button 42B according to the presentembodiment is performed as follows.

Referring to FIG. 14A, in the state in which the intestine wall 94 isdrawn to the pierced portion 92 in the stomach wall 90, the endoscope 22is inserted through a mouthpiece 98 (FIG. 19) attached to the patient'smouth. The distal end of the endoscope 22 is disposed opposite to thepierced portion 92 and the intestine wall 94 is pierced by an incisioninstrument such as a high-frequency knife inserted through the channelin the endoscope 22. At that time, although the housing 64 is attachedto the distal end 22 a, it does not disturb the piercing operationbecause the housing 64 has a cylindrical shape.

Subsequently, referring to FIG. 15, the distal end of the housing 64 isinserted through an orifice formed in the intestine wall 94 and theoperation knob 72 for the outer cylindrical portion 64 b shown in FIG.19 is drawn to move the outer cylindrical portion 64 b backward.Consequently, the first segment 43 of the anastomosis button 42B isexposed and the flange portion 38 is developed in the original circularshape due to elasticity. After that, the endoscope 22 is withdrawn topull the inner cylindrical portion 64 a of the housing 64 out of thefirst segment 43. At that time, since the flange portion 38 is broughtinto contact with the inner surface of the intestine wall 94, the firstsegment 43 is held in the small intestine.

Subsequently, as shown in FIG. 16, the endoscope 22, in which thehousing 64 receiving the second disc-like segment 38 a is attached tothe distal end 22 a, is inserted into the stomach to allow the distalend to face the first segment 43 of the anastomosis button previouslyattached. The housing 64 is allowed to coaxially match the end, in whichthe diameter is reduced, of the main body portion 40 of the firstsegment 43 and is then close thereto. After that, the outer cylindricalportion 64 b of the housing 64 is withdrawn and the rotation knob 80provided for the operation section of the endoscope 22 is rotated towind the discharging threads 78 around the button operation main body 8.Consequently, as shown in FIG. 17, the second segment 38 a is returnedto the original disc shape on the inner cylindrical portion 64 a and isthen discharged by the beads 76 to be attached onto the main bodyportion 40 of the first segment 43. In this instance, the first segment43 can be held by a grasping forceps (not shown) inserted through thechannel in the endoscope 22.

Since the present embodiment has been explained in association with thegastroenterostomy, the example in which the anastomosis button wasinserted through the mouth has been described. Optionally, in accordancewith a portion to be anastomosed, it is obvious that the anastomosisbutton can be inserted through the anus. The members in the embodimentscan be properly combined to each other and they are not limited to anyembodiment.

Consequently, according to the anastomosis system 10 of theabove-mentioned embodiments, since the anastomosis button can be easilyinserted through the mouth or the anus into the coelom, the burden onthe patient is extremely little. Moreover, since it takes a remarkablyshort time, the system can be generally used in other applications inaddition to the above-mentioned gastroenterostomy.

Additional advantages and modifications will readily occur to thoseskilled in the art. Therefore, the invention in its broader aspects isnot limited to the specific details and representative embodiments shownand described herein. Accordingly, various modifications may be madewithout departing from the spirit or scope of the general inventiveconcept as defined by the appended claims and their equivalents.

1. An anastomosis system for performing a gastrojejunostomy in a body,comprising: an anastomosis button, which includes two elastic andfoldable circular flange portions and a tubular main body portionextending between the flange portions, to couple two lumen portions inthe body to each other each of the flange portions having a circularform with a rim to increase bending strength; a housing in which theanastomosis button can be received as the flange portions are folded,wherein the housing comprises two cylindrical members, which relativelymove axially to stepwise eject the anastomosis button; a guide whichincludes a distal end to be inserted through at least one of a mouth andan anus to a target portion in the body and a proximal end arranged onthe outside of the body and which guides the housing to the targetportion; incising means for incising a lumen wall of the target portionand a counterpart lumen wall to be anastomosed; inserting means forinserting one end of the housing via an incision formed in the lumenwall of the target portion into an incision formed in the counterpartlumen wall to be anastomosed; ejecting means for ejecting theanastomosis button from the housing; and expanding means for expandingthe flange portions of the anastomosis button to be greater in diameteras compared to the housing, thereby holding the two lumen walls betweenthe two flange portions.
 2. The anastomosis system according to claim 1,wherein the guide comprises a flexible multi-lumen tube including atleast a lumen through which an endoscope is inserted and a lumen throughwhich the release line is inserted.
 3. The anastomosis system accordingto claim 2, further comprising: an operation shaft which has a distalend supporting the housing and a proximal end arranged on the outside ofthe body, the tube further comprising a lumen through which theoperation shaft is inserted and a large-diameter space which is formedat the distal end and which receives the housing, the lumens throughwhich the endoscope, the release line, and the operation shaft areinserted, respectively, being terminated in the large-diameter space,and the distal end of the housing and the distal end of the release lineprotruding outwardly from the large-diameter space.
 4. The anastomosissystem according to claim 2, wherein the tube further comprises anorifice through which the distal end of the endoscope protrudesoutwardly in the radial direction from the inside.
 5. The anastomosissystem according to claim 1, further comprising: a pulling line whichhas a distal end to be inserted to the target portion along the guideand a proximal end arranged on the outside of the body and which pullsan organic tissue in the vicinity of the target portion.
 6. Theanastomosis system according to claim 1, wherein at least a portion inthe vicinity of the distal end of the guide is made of a transparentmaterial.
 7. The anastomosis system according to claim 1, furthercomprising an operation shaft which has a first end connected to thehousing and a second end extending from the first end toward theproximal end of the guide, the operation shaft being inserted in theguide to allow movement relative to the guide so that the housing ismovable between a first position in which the housing is held in theguide and a second position in which the housing is projected out of thedistal end of the guide.